Apple gets tough on medication dosage apps

By: Brian Dolan | Jun 6, 2013        

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Brian Dolan, Editor, MobiHealthNewsApple’s review process for the apps angling to get into the AppStore has long been a pain point for developers. This week physician-led medical app review site iMedicalApps pointed out that a number of medical app developers have received rejection notices from Apple because they included medication dosage information in their app, and Apple says it only accepts medical dosage information submitted by the medicine’s manufacturer.

While it’s tempting to suggest, as iMedicalApps did, that this is a sign of some kind of response from Apple to the recent attention the uChek app has received for its letter from the FDA, Apple has actually been sending these kinds of rejection letters to drug reference app developers for at least a year now — long before uChek got into its regulatory imbroglio two weeks ago.

Back in July 2012 one frustrated developer anonymously recounted their experience of repeated rejections of a medical app: “First I tried referencing the FDA website directly, then I tried removing the brand names and only use the generic. Still, Apple rejected and in the last correspondence they told me that unless I manufacture the drugs I cannot make an app that references them.” The last line might be overstating it, but you get the point. Based on his posts in the forum, in December 2012 this developer gave up on his medical app after six months of fighting Apple on an appeal and went back to creating games and other non-medical apps.

By January 2013 another medical app developer has posted about a similar saga. Vitaliy Salnikov shared his experience trying to get his latest drug reference app into the AppStore on his medical app software company’s blog. Salnikov also posted his rejection letter from Apple, which cited the same section of the developer agreement that Apple used as a reason to reject the others:

“We found that the Seller and/or Artist names associated with your app do not reflect the name of the manufacturer of the medicine referenced in your app or its metadata, as required by the iOS Developer Program License Agreement,” Apple wrote. It also noted: “We can only accept medical dosage calculators submitted by the medicine’s manufacturer.”

Notably, Salnikov’s development shop, Anaesthsoftware already has two drug reference apps up for sale in the AppStore, which appear to offer very similar features. The app that got rejected, Pocket Intensive Care Assistant (PICA), was first submitted to the AppStore in November and was rejected six times, Salnikov writes on his company’s blog.

Of course, Android apps don’t receive the kind of scrutiny that Apple iOS ones get. PICA is actually up for sale in the Google Play store right now. The PICA app is billed as “medical software that contains all [the] features that [an] ICU doctor needs” and it helps users “calculate the infusion rate of inotropic drugs, vasopressors and vasodilatators.” The app boasts a user-friendly interface that lets users “change the infusion rate of medication (mL and mcg/kg/min simultaneously) by simply moving his finger in a circle.”

Just a few weeks ago a Spain-based medical app developer posted a similar story and a similar rejection letter from Apple, which stated: “We can only accept medical dosage information submitted by the medicine’s manufacturer.”

As it is notoriously secretive, Apple doesn’t make it easy to understand what’s going on here, but the passage it continuously cites from its developer agreement to explain the rejection is not new. The original intent of this section was to ensure that developers contracted by companies to create an app on their behalf were not the ones submitting the app for review. The company that hired them has to do it. (When this rule first went into effect in July 2011 it made things difficult for some do-it-yourself build your own app tools.)

By stretching this rule to drug dosage information, Apple appears to be taking a more active role in determining whether a medical app is providing trustworthy information. That is a slippery slope and one that will likely require Apple to hire a considerable amount of medical expertise to execute.

In the meantime, you likely won’t hear too much from rejected medical app developers — at least from those that want to continue to develop apps for iOS. Here’s Apple’s advice to developers whose apps get rejected, from the developer agreement they all must sign:

“If your app is rejected, we have a review board that you can appeal to. If you run to the press and trash us, it never helps.”


Kerry Kennedy: Mobile devices solve healthcare problems

By: Neil Versel | Jun 6, 2013        

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Neil_Versel_LargeAs president of the Robert F. Kennedy Center for Justice and Human Rights and daughter of its namesake, Kerry Kennedy has been all over the world. “In nearly every place I visit, access to quality healthcare is a problem,” she says.

In many of those places, Internet service and even electricity are unreliable, which is why Kennedy is such a fan of mobile devices for delivering healthcare services and information when the things people in the West take for granted aren’t always available.

I know Kennedy because we both have served on the advisory board of Health eVillages, a program that provides medical reference tools and educational material on mobile devices to health professionals in low-resource regions of the world, since its launch in 2011. I go to the meetings and offer tips and contacts as needed, but the real vision and execution for the program come from the two co-founders, Kennedy and Donato Tramuto, CEO and vice chairman of Physician’s Interactive Holdings, parent company of mobile medical reference software vendor Skyscape.

The idea for Health eVillages came about after the January 2010 earthquake that devastated Haiti. Kennedy had been telling Trumato about some of the work the RFK Center was doing on healthcare issues in that desperately poor nation, and Trumato suggested they try iPhones and iPod Touches with pre-loaded medical content that can be accessed offline.

Since that time, Health eVillages has launched pilots in Haiti, Kenya, Uganda and most recently, right here in the U.S., at a clinic in Franklin, La., where more than 80 percent of the population lives below the federal poverty line. In all of those locations, nurses and other health workers are overwhelmed with patients — physicians are not always available — and medical texts are either years out of date or simply nonexistent. Mobile devices bring up-to-date resources for both treatment and educational purposes.

“Clinicians for the first time have their fingers on current healthcare information,” Kennedy says.

The great thing about smartphones is that they are readily customized; devices can be loaded with different apps to fit each situation. “One of the great strengths of this program,” Kennedy says, “is that it’s not one-size-fits-all.”

In the case of the Louisiana site, money the clinic would have spent on books now can be spent on medical supplies and other critical needs.

Elsewhere, the technology allows patients to go outside the national health system, which might be important for political reasons. One Health eVillages site is in a region where homosexuality is criminalized, according to Kennedy.

“People who go into the hospital can lose their job and housing and be ostracized by their communities,” Kennedy says. Locals started an alternative clinic to get around this problem, but lack a doctor. “They’re relying on Health eVillages devices to diagnose illnesses and give treatments,” she says.

Seamless Medical gets $2M to bring iPads to waiting rooms

By: Jonah Comstock | Jun 5, 2013        

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snapSeamless Medical Systems, a 2-year-old Santa Fe, New Mexico-based startup, has announced a cumulative seed funding raise of $2 million. The money comes from individual, local angel investors, according to CEO and founder David Perez, about a third of whom are physicians themselves. The company is hoping to raise an additional $3 million this summer, Perez told MobiHealthNews.

Seamless currently has one product, an iPad patient check-in platform called SNAP Practice. Perez said the company currently has about a dozen customers, all private practices, although some hospitals, including a military hospital have expressed interest.

“I basically got started because I was a patient and I was sitting in the waiting room in my doctor’s office and had this clipboard and this stack of papers I was filling out,” Perez told MobiHealthNews. “And I got to the fifth piece of paper, filling out my social security number for the fifth time, and I just thought ‘There has got to be a better way.’ That’s when it really dawned on me that I could fill in all that information on the iPad, I could read those magazines on the iPad, and I’d probably be more willing to read about medical information on my iPad.”

Currently SNAP Practice is loaded onto dedicated iPads that are handed out to patients in the waiting room in lieu of clipboards. Patients can fill out their intake forms on the iPads and read magazines, as well as access health information content, provided by Mayo Clinic. In version 2 of the software, the app will contain a virtual health magazine, customized to the user by age, gender, and health condition. The company is also hoping to create a Spanish version.

Seamless’s offering is similar to that of NYC-based startup Phreesia, which has been in the space since 2005, although Phreesia uses a dedicated tablet rather than an iPad. Another company, Digital Assent, offers a similar dedicated patient check-in tablet called PatientPad.

Future plans for Seamless include moving the patient engagement outside of the doctor’s office entirely. The goal, Perez said, “is to be able to reach [patients] outside the walls of the clinic. Pick up signals from wireless glucometers and blood pressure cuffs and send that information back to the EHR. Patients can have their own account called SnapForMe. This will allow patients to be empowered with access.”

Perez says he wouldn’t describe the product as an app, although it can be downloaded from the App Store. “It’s a cloud-based enterprise software that runs on an iPad,” he said. “We do have an Android version in the works for early next year, and Microsoft Surface we have in our sites as well.”

Rock Health’s 5th class: Google Glass for health, smart spoons, and Roni Zeiger’s Smart Patients

By: Jonah Comstock | Jun 5, 2013        

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Rock Health new officeSan Francisco-based digital health accelerator Rock Health announced their fifth class this week. The eleven startups will receive $100,000 in investment and a variety of other perks during their four months in the program.

This class will also be the last one to work out of Rock’s old office, in San Francisco’s Chinatown. After this class’s conclusion, the program will move into new office space in Mission Bay, near UCSF’s Center for Digital Health Innovation. The new space is owned by Alexandria Real Estate, whose affiliated venture firm, Alexandria Real Estate Equities, is a new corporate partner for Rock Health. The accelerator also just announced two other new partners: pharmaceutical company Boehringer Ingelheim and public relations firm Ogilvy Public Relations. (Correction: A previous version of this story said the fifth class would be the first class in the new office, rather than the last class in the old office, which is accurate.)

“Each of these companies not only recognizes the potential for digital health but is also passionate about engaging with the startup ecosystem. We’re excited to add their perspectives and expertise to our program and look forward to working alongside them in helping our entrepreneurs build successful, sustainable businesses in healthcare,” Rock Health CEO Halle Tecco wrote in a blog post announcing the new class.

Two of the companies in the new class have Google connections: former Google Health chief strategist Roni Zeiger is the founder of Smart Patients, and Augmedix is one of the first startups that aims to leverage Google Glass for healthcare. Other than those two, most of the companies in the new class are relatively unknown or early stage companies.

Here are the companies in Rock Health class number five:

– Eric Page, founder of Amplify Health, previously ran a sleep clinic called REM Medical, which used a pay-for-outcomes rather than a fee-for-service payment structure. Page discovered that the best way to increase adherence and therefore outcomes was to focus on building strong relationships between patients and providers, he writes in a blog post. Amplify was founded to turn that discovery into a company. They use software and analytics to keep doctors and patients connected, engage patients, and measure outcomes. The startup has already worked with at least one customer, Paladina Health Clinic, a subsidiary of Denver-based DaVita Healthcare.

– Anapsis has no web presence yet. Tecco describes it as “a research platform and marketplace for scientific and statistical computing.”

– Augmedix is sure to get a fair amount of press attention over the next few months for its connection to Google’s controversial and much-hyped augmented reality glasses project Google Glass. The company, whose founders have been among the lucky few to try out the high-tech specs, hopes to be first on the scene with a Google Glass app for medical doctors. Ian Shakil, one of the founders, previously worked with Cambridge, Mass.-based sports wearable company MC10. “Technology can free physicians and allow them to focus on what they do best,” the founders write on their website, “taking care of patients.”

– CancerIQ is a web-based data sharing platform for oncology-related data. According to its website, the company’s big data platform “converts oncology data stored in unstructured enterprise data warehouses into research-quality data for secondary use.” The system, which spun out of the University of Chicago, can incorporate and process genomic data as well as medical images.

– CRIXLabs has developed a software platform called NuSilico, designed to help pharma companies find “the next blockbuster drug.” It’s a predictive analysis software for nanoparticle drug candidates, to save pharma companies the expense of going down unproductive drug development allies.

– Another stealthy startup, Fluid, is a flu diagnostic tool, according to Rock Health. It promises to diagnose influenza “in minutes, without the doctor’s visit.”

– Lift Labs is building a smart spoon, among other things. But the company has a much more clinical focus than smart fork maker HAPILabs. Their spoon is one of several smart tools for combatting the tremors inherent in diseases like Parkinson’s. The company also has Apple and Android apps available to measure tremors (Lift Pulse) and to help people with Parkinson’s prevent shuffling as they walk (Lift Stride).

– Sensentia is “developing a new breed of intelligent systems for healthcare administration and operation,” according to Rock Health. On the company’s own website, it describes itself as “striving to enable the next paradigm of knowledge automation and computational reasoning.” Essentially, the company appears to be building an automated system for handling health insurance queries that are currently handled by human agents. According to Angel List, the company is headed up by former GE employee Juan Junglaus and serial entrepreneur Ronin Amit. The company already claims Humana as a customer.

– MobiHealthNews already wrote about Roni Zeiger’s new startup Smart Patients back in April. The online community for cancer patients and care providers is certainly one of the most high-profile startups in the new class.

– Spire is working on a wearable sensor that “tracks both physical and psychological fitness to lower stress and increase productivity,” according to Rock Health. The device is designed to help people change the way they breathe.

– Finally, ThriveOn is a startup working on mobile mental health programs. Rock Health says the programs are “customized for every individual” from screen to treatment.

To combat battery woes, all-day activity trackers might just need a little SolePower

By: Jonah Comstock | Jun 5, 2013        

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SolePowerAs wearable all-day activity trackers compete to be smaller, more convenient, and more comfortable, there’s one problem many of the newer entrants are running into: battery life. If users are supposed to be wearing a tracker all the time, when do they plug it in? And the point when a user takes off a wearable device to plug it into the wall is the point when they’re most likely to lose interest or abandon it.

“The battery thing is really a big deal,” Misfit Wearables CEO Sonny Vu told MobiHealthNews in a recent interview. His company’s Shine tracker is expected to launch later this summer, and he says they’re prioritizing battery life. “I’m not sure we’re even within a generation of science to solve some of the power issues. … I think we should be shooting for 2 to 3 years of battery life, and it’s about being as miserly as possible with your power use to make it a great experience.”

BodyMedia CEO Christine Robins agreed. Her company’s Core armband is on the high end of the spectrum, with an hour of charge providing 7 to 10 days of use.

“Some of the other products take some charging or they don’t hold a battery quite as long,” she said. “It’s a challenge in the market especially as you get into Bluetooth, Bluetooth LE. There’s a lot of power consumption there.”

But the solution, or a solution, might be no farther away than a quick scroll down the Kickstarter main page from the latest crowdfunded activity tracker. Pittsburgh-based startup SolePower is crowdfunding a removable insole that aims to charge electronics via the kinetic energy of the user’s everyday walking. The company’s goal is to fully charge an iPhone in 2.5 miles of walking, the average movement a person does in a day. And for the wrist, which is shaping up to be some of the hottest real estate for wearable trackers, watch maker Seiko already offers a self-charging watch called Kinetic that operates on a similar principle to SolePower.

Activity tracker customers are almost by definition moving more than average, so this technology seems like a natural fit, no pun intended. Conceivably, a shoe- or wrist-worn tracker could be designed that would never need charging, as long as the user kept their activity up.

In a crowded field where everyone is looking for an edge over the competition, it seems like it will only be a matter of time before we see an activity-powered activity tracker.

Miami Children’s Hospital adds indoor GPS directions, gift giving to patient app

By: Aditi Pai | Jun 5, 2013        

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MiamigiftsIn the newest version of Miami Children’s Hospital’s patient-facing iPhone app, the hospital offers a WiFi-enabled GPS system that tracks where the user is within the hospital and tells them how they can get to their desired location.

Additionally, the app now allows families to deliver cafeteria food or gifts to a patient in the hospital. Gifts that families can send include balloons, stuffed animals, clothing and more.

Since launch, the app, Fit4KidsCare has helped patients to locate Miami Children’s Hospital facilities, make appointments and check hours of operation for the different Miami Children’s Hospital locations.

Fit4KidsCare has a child-friendly design with pictures and colors designating the different functions of the app.

While this app is free, the hospital’s other app, ScripteRx costs $0.99 and helps patients and their parents remember to follow their medication regimen as instructed. ScripteRx, developed by pediatric specialists, is designed to put an entire family’s medication schedules within a single app.

Miami Children’s worked with Meridian Apps to develop the new indoor GPS-enabled directions feature of the app. Just a few weeks ago Meridian was acquired by enterprise WiFi powerhouse Aruba Networks for an undisclosed sum.

Last year, Miami Children’s Hospital partnered with Patient Point, a provider of care coordination and patient care management. As part of the deal, Patient Point planned to set up a care coordination iOS based system for clinicians. It also aimed to introduce a number of patient engagement offerings like wellness-focused games, apps for check-in and check-out, medication adherence apps, and interactive clinical surveys.